|
DOTAREM INJ 10X10ML VIAL
|
Facility
|
IP
|
$553.00
|
|
| Hospital Charge Code |
6550195
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$320.46 |
| Max. Negotiated Rate |
$553.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$541.94
|
| Rate for Payer: Aetna of WY Medicare |
$353.92
|
| Rate for Payer: Altius Commercial |
$530.88
|
| Rate for Payer: Beech Street Commercial |
$541.94
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$536.41
|
| Rate for Payer: Cash Price |
$387.10
|
| Rate for Payer: ChoiceCare Network Commercial |
$536.41
|
| Rate for Payer: Cigna of WY Commercial |
$541.94
|
| Rate for Payer: Entrust Commercial |
$525.35
|
| Rate for Payer: First Choice Health Commercial |
$525.35
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$525.35
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$337.33
|
| Rate for Payer: HealthUtah PPO |
$553.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$536.41
|
| Rate for Payer: Multiplan Medicare/VA |
$320.46
|
| Rate for Payer: One Health Plan of WY PPO |
$541.94
|
| Rate for Payer: PacificSource Commercial |
$497.70
|
| Rate for Payer: PHCS PPO |
$541.94
|
| Rate for Payer: Three Rivers PPO |
$414.75
|
| Rate for Payer: TriWest Veterans Administration |
$337.33
|
| Rate for Payer: United Healthcare Commercial |
$528.12
|
| Rate for Payer: United Healthcare Medicare |
$337.33
|
| Rate for Payer: WINHealth Partners Commercial |
$525.35
|
| Rate for Payer: Wise Provider Network Commercial |
$525.35
|
|
|
DOTAREM INJ 10X15ML VIAL
|
Facility
|
OP
|
$1,071.00
|
|
| Hospital Charge Code |
6550196
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$579.95 |
| Max. Negotiated Rate |
$1,071.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,049.58
|
| Rate for Payer: Aetna of WY Medicare |
$706.86
|
| Rate for Payer: Altius Commercial |
$1,028.16
|
| Rate for Payer: Beech Street Commercial |
$1,049.58
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1,038.87
|
| Rate for Payer: Cash Price |
$749.70
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,038.87
|
| Rate for Payer: Cigna of WY Commercial |
$1,049.58
|
| Rate for Payer: Entrust Commercial |
$1,017.45
|
| Rate for Payer: First Choice Health Commercial |
$1,017.45
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,017.45
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$610.47
|
| Rate for Payer: HealthUtah PPO |
$1,071.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,038.87
|
| Rate for Payer: Multiplan Medicare/VA |
$579.95
|
| Rate for Payer: One Health Plan of WY PPO |
$1,049.58
|
| Rate for Payer: PacificSource Commercial |
$963.90
|
| Rate for Payer: PHCS PPO |
$1,049.58
|
| Rate for Payer: Three Rivers PPO |
$803.25
|
| Rate for Payer: TriWest Veterans Administration |
$610.47
|
| Rate for Payer: United Healthcare Commercial |
$1,022.80
|
| Rate for Payer: United Healthcare Medicare |
$610.47
|
| Rate for Payer: WINHealth Partners Commercial |
$1,049.58
|
| Rate for Payer: Wise Provider Network Commercial |
$1,017.45
|
|
|
DOTAREM INJ 10X15ML VIAL
|
Facility
|
IP
|
$1,071.00
|
|
| Hospital Charge Code |
6550196
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$620.64 |
| Max. Negotiated Rate |
$1,071.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,049.58
|
| Rate for Payer: Aetna of WY Medicare |
$685.44
|
| Rate for Payer: Altius Commercial |
$1,028.16
|
| Rate for Payer: Beech Street Commercial |
$1,049.58
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1,038.87
|
| Rate for Payer: Cash Price |
$749.70
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,038.87
|
| Rate for Payer: Cigna of WY Commercial |
$1,049.58
|
| Rate for Payer: Entrust Commercial |
$1,017.45
|
| Rate for Payer: First Choice Health Commercial |
$1,017.45
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,017.45
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$653.31
|
| Rate for Payer: HealthUtah PPO |
$1,071.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,038.87
|
| Rate for Payer: Multiplan Medicare/VA |
$620.64
|
| Rate for Payer: One Health Plan of WY PPO |
$1,049.58
|
| Rate for Payer: PacificSource Commercial |
$963.90
|
| Rate for Payer: PHCS PPO |
$1,049.58
|
| Rate for Payer: Three Rivers PPO |
$803.25
|
| Rate for Payer: TriWest Veterans Administration |
$653.31
|
| Rate for Payer: United Healthcare Commercial |
$1,022.80
|
| Rate for Payer: United Healthcare Medicare |
$653.31
|
| Rate for Payer: WINHealth Partners Commercial |
$1,017.45
|
| Rate for Payer: Wise Provider Network Commercial |
$1,017.45
|
|
|
DOTAREM INJ 10X20ML VIAL
|
Facility
|
OP
|
$1,071.00
|
|
| Hospital Charge Code |
6550197
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$579.95 |
| Max. Negotiated Rate |
$1,071.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,049.58
|
| Rate for Payer: Aetna of WY Medicare |
$706.86
|
| Rate for Payer: Altius Commercial |
$1,028.16
|
| Rate for Payer: Beech Street Commercial |
$1,049.58
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1,038.87
|
| Rate for Payer: Cash Price |
$749.70
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,038.87
|
| Rate for Payer: Cigna of WY Commercial |
$1,049.58
|
| Rate for Payer: Entrust Commercial |
$1,017.45
|
| Rate for Payer: First Choice Health Commercial |
$1,017.45
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,017.45
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$610.47
|
| Rate for Payer: HealthUtah PPO |
$1,071.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,038.87
|
| Rate for Payer: Multiplan Medicare/VA |
$579.95
|
| Rate for Payer: One Health Plan of WY PPO |
$1,049.58
|
| Rate for Payer: PacificSource Commercial |
$963.90
|
| Rate for Payer: PHCS PPO |
$1,049.58
|
| Rate for Payer: Three Rivers PPO |
$803.25
|
| Rate for Payer: TriWest Veterans Administration |
$610.47
|
| Rate for Payer: United Healthcare Commercial |
$1,022.80
|
| Rate for Payer: United Healthcare Medicare |
$610.47
|
| Rate for Payer: WINHealth Partners Commercial |
$1,049.58
|
| Rate for Payer: Wise Provider Network Commercial |
$1,017.45
|
|
|
DOTAREM INJ 10X20ML VIAL
|
Facility
|
IP
|
$1,071.00
|
|
| Hospital Charge Code |
6550197
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$620.64 |
| Max. Negotiated Rate |
$1,071.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,049.58
|
| Rate for Payer: Aetna of WY Medicare |
$685.44
|
| Rate for Payer: Altius Commercial |
$1,028.16
|
| Rate for Payer: Beech Street Commercial |
$1,049.58
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1,038.87
|
| Rate for Payer: Cash Price |
$749.70
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,038.87
|
| Rate for Payer: Cigna of WY Commercial |
$1,049.58
|
| Rate for Payer: Entrust Commercial |
$1,017.45
|
| Rate for Payer: First Choice Health Commercial |
$1,017.45
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,017.45
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$653.31
|
| Rate for Payer: HealthUtah PPO |
$1,071.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,038.87
|
| Rate for Payer: Multiplan Medicare/VA |
$620.64
|
| Rate for Payer: One Health Plan of WY PPO |
$1,049.58
|
| Rate for Payer: PacificSource Commercial |
$963.90
|
| Rate for Payer: PHCS PPO |
$1,049.58
|
| Rate for Payer: Three Rivers PPO |
$803.25
|
| Rate for Payer: TriWest Veterans Administration |
$653.31
|
| Rate for Payer: United Healthcare Commercial |
$1,022.80
|
| Rate for Payer: United Healthcare Medicare |
$653.31
|
| Rate for Payer: WINHealth Partners Commercial |
$1,017.45
|
| Rate for Payer: Wise Provider Network Commercial |
$1,017.45
|
|
|
DOT PHYSICAL
|
Professional
|
Both
|
$100.00
|
|
|
Service Code
|
HCPCS TY019
|
| Min. Negotiated Rate |
$75.00 |
| Max. Negotiated Rate |
$100.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$98.00
|
| Rate for Payer: Beech Street Commercial |
$95.00
|
| Rate for Payer: Cash Price |
$70.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$97.00
|
| Rate for Payer: Cigna of WY Commercial |
$98.00
|
| Rate for Payer: First Choice Health Commercial |
$90.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$95.00
|
| Rate for Payer: HealthUtah PPO |
$100.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$97.00
|
| Rate for Payer: One Health Plan of WY PPO |
$98.00
|
| Rate for Payer: PacificSource Commercial |
$90.00
|
| Rate for Payer: PHCS PPO |
$95.00
|
| Rate for Payer: Three Rivers PPO |
$75.00
|
| Rate for Payer: United Healthcare Commercial |
$95.00
|
| Rate for Payer: WINHealth Partners Commercial |
$95.00
|
|
|
DOUBLE SWIVEL CONNECTOR
|
Facility
|
OP
|
$18.18
|
|
| Hospital Charge Code |
2500235
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$9.84 |
| Max. Negotiated Rate |
$18.18 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$17.82
|
| Rate for Payer: Aetna of WY Medicare |
$12.00
|
| Rate for Payer: Altius Commercial |
$17.45
|
| Rate for Payer: Beech Street Commercial |
$17.82
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$17.63
|
| Rate for Payer: Cash Price |
$12.73
|
| Rate for Payer: ChoiceCare Network Commercial |
$17.63
|
| Rate for Payer: Cigna of WY Commercial |
$17.82
|
| Rate for Payer: Entrust Commercial |
$17.27
|
| Rate for Payer: First Choice Health Commercial |
$17.27
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$17.27
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$10.36
|
| Rate for Payer: HealthUtah PPO |
$18.18
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$17.63
|
| Rate for Payer: Multiplan Medicare/VA |
$9.84
|
| Rate for Payer: One Health Plan of WY PPO |
$17.82
|
| Rate for Payer: PacificSource Commercial |
$16.36
|
| Rate for Payer: PHCS PPO |
$17.82
|
| Rate for Payer: Three Rivers PPO |
$13.64
|
| Rate for Payer: TriWest Veterans Administration |
$10.36
|
| Rate for Payer: United Healthcare Commercial |
$17.36
|
| Rate for Payer: United Healthcare Medicare |
$10.36
|
| Rate for Payer: WINHealth Partners Commercial |
$17.82
|
| Rate for Payer: Wise Provider Network Commercial |
$17.27
|
|
|
DOUBLE SWIVEL CONNECTOR
|
Facility
|
IP
|
$18.18
|
|
| Hospital Charge Code |
2500235
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$10.54 |
| Max. Negotiated Rate |
$18.18 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$17.82
|
| Rate for Payer: Aetna of WY Medicare |
$11.64
|
| Rate for Payer: Altius Commercial |
$17.45
|
| Rate for Payer: Beech Street Commercial |
$17.82
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$17.63
|
| Rate for Payer: Cash Price |
$12.73
|
| Rate for Payer: ChoiceCare Network Commercial |
$17.63
|
| Rate for Payer: Cigna of WY Commercial |
$17.82
|
| Rate for Payer: Entrust Commercial |
$17.27
|
| Rate for Payer: First Choice Health Commercial |
$17.27
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$17.27
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$11.09
|
| Rate for Payer: HealthUtah PPO |
$18.18
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$17.63
|
| Rate for Payer: Multiplan Medicare/VA |
$10.54
|
| Rate for Payer: One Health Plan of WY PPO |
$17.82
|
| Rate for Payer: PacificSource Commercial |
$16.36
|
| Rate for Payer: PHCS PPO |
$17.82
|
| Rate for Payer: Three Rivers PPO |
$13.64
|
| Rate for Payer: TriWest Veterans Administration |
$11.09
|
| Rate for Payer: United Healthcare Commercial |
$17.36
|
| Rate for Payer: United Healthcare Medicare |
$11.09
|
| Rate for Payer: WINHealth Partners Commercial |
$17.27
|
| Rate for Payer: Wise Provider Network Commercial |
$17.27
|
|
|
DOXORUBICIN 2 MG/ML INTRAVENOUS SOLUTION (WRAPPED) [4000713]
|
Facility
|
OP
|
$18.93
|
|
|
Service Code
|
HCPCS J9000
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$10.25 |
| Max. Negotiated Rate |
$18.93 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$18.55
|
| Rate for Payer: Aetna of WY Medicare |
$12.49
|
| Rate for Payer: Altius Commercial |
$18.17
|
| Rate for Payer: Beech Street Commercial |
$18.55
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$18.36
|
| Rate for Payer: Cash Price |
$13.25
|
| Rate for Payer: ChoiceCare Network Commercial |
$18.36
|
| Rate for Payer: Cigna of WY Commercial |
$18.55
|
| Rate for Payer: Entrust Commercial |
$17.98
|
| Rate for Payer: First Choice Health Commercial |
$17.98
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$17.98
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$10.79
|
| Rate for Payer: HealthUtah PPO |
$18.93
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$18.36
|
| Rate for Payer: Multiplan Medicare/VA |
$10.25
|
| Rate for Payer: One Health Plan of WY PPO |
$18.55
|
| Rate for Payer: PacificSource Commercial |
$17.04
|
| Rate for Payer: PHCS PPO |
$18.55
|
| Rate for Payer: Three Rivers PPO |
$14.20
|
| Rate for Payer: TriWest Veterans Administration |
$10.79
|
| Rate for Payer: United Healthcare Commercial |
$18.08
|
| Rate for Payer: United Healthcare Medicare |
$10.79
|
| Rate for Payer: WINHealth Partners Commercial |
$18.55
|
| Rate for Payer: Wise Provider Network Commercial |
$17.98
|
|
|
DOXORUBICIN 2 MG/ML INTRAVENOUS SOLUTION (WRAPPED) [4000713]
|
Facility
|
IP
|
$18.93
|
|
|
Service Code
|
HCPCS J9000
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$10.97 |
| Max. Negotiated Rate |
$18.93 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$18.55
|
| Rate for Payer: Aetna of WY Medicare |
$12.12
|
| Rate for Payer: Altius Commercial |
$18.17
|
| Rate for Payer: Beech Street Commercial |
$18.55
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$18.36
|
| Rate for Payer: Cash Price |
$13.25
|
| Rate for Payer: ChoiceCare Network Commercial |
$18.36
|
| Rate for Payer: Cigna of WY Commercial |
$18.55
|
| Rate for Payer: Entrust Commercial |
$17.98
|
| Rate for Payer: First Choice Health Commercial |
$17.98
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$17.98
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$11.55
|
| Rate for Payer: HealthUtah PPO |
$18.93
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$18.36
|
| Rate for Payer: Multiplan Medicare/VA |
$10.97
|
| Rate for Payer: One Health Plan of WY PPO |
$18.55
|
| Rate for Payer: PacificSource Commercial |
$17.04
|
| Rate for Payer: PHCS PPO |
$18.55
|
| Rate for Payer: Three Rivers PPO |
$14.20
|
| Rate for Payer: TriWest Veterans Administration |
$11.55
|
| Rate for Payer: United Healthcare Commercial |
$18.08
|
| Rate for Payer: United Healthcare Medicare |
$11.55
|
| Rate for Payer: WINHealth Partners Commercial |
$17.98
|
| Rate for Payer: Wise Provider Network Commercial |
$17.98
|
|
|
DOXORUBICIN 50 MG/25 ML INTRAVENOUS SOLUTION [54482]
|
Facility
|
IP
|
$18.93
|
|
|
Service Code
|
HCPCS J9000
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$10.97 |
| Max. Negotiated Rate |
$18.93 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$18.55
|
| Rate for Payer: Aetna of WY Medicare |
$12.12
|
| Rate for Payer: Altius Commercial |
$18.17
|
| Rate for Payer: Beech Street Commercial |
$18.55
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$18.36
|
| Rate for Payer: Cash Price |
$13.25
|
| Rate for Payer: ChoiceCare Network Commercial |
$18.36
|
| Rate for Payer: Cigna of WY Commercial |
$18.55
|
| Rate for Payer: Entrust Commercial |
$17.98
|
| Rate for Payer: First Choice Health Commercial |
$17.98
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$17.98
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$11.55
|
| Rate for Payer: HealthUtah PPO |
$18.93
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$18.36
|
| Rate for Payer: Multiplan Medicare/VA |
$10.97
|
| Rate for Payer: One Health Plan of WY PPO |
$18.55
|
| Rate for Payer: PacificSource Commercial |
$17.04
|
| Rate for Payer: PHCS PPO |
$18.55
|
| Rate for Payer: Three Rivers PPO |
$14.20
|
| Rate for Payer: TriWest Veterans Administration |
$11.55
|
| Rate for Payer: United Healthcare Commercial |
$18.08
|
| Rate for Payer: United Healthcare Medicare |
$11.55
|
| Rate for Payer: WINHealth Partners Commercial |
$17.98
|
| Rate for Payer: Wise Provider Network Commercial |
$17.98
|
|
|
DOXORUBICIN 50 MG/25 ML INTRAVENOUS SOLUTION [54482]
|
Facility
|
OP
|
$18.93
|
|
|
Service Code
|
HCPCS J9000
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$10.25 |
| Max. Negotiated Rate |
$18.93 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$18.55
|
| Rate for Payer: Aetna of WY Medicare |
$12.49
|
| Rate for Payer: Altius Commercial |
$18.17
|
| Rate for Payer: Beech Street Commercial |
$18.55
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$18.36
|
| Rate for Payer: Cash Price |
$13.25
|
| Rate for Payer: ChoiceCare Network Commercial |
$18.36
|
| Rate for Payer: Cigna of WY Commercial |
$18.55
|
| Rate for Payer: Entrust Commercial |
$17.98
|
| Rate for Payer: First Choice Health Commercial |
$17.98
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$17.98
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$10.79
|
| Rate for Payer: HealthUtah PPO |
$18.93
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$18.36
|
| Rate for Payer: Multiplan Medicare/VA |
$10.25
|
| Rate for Payer: One Health Plan of WY PPO |
$18.55
|
| Rate for Payer: PacificSource Commercial |
$17.04
|
| Rate for Payer: PHCS PPO |
$18.55
|
| Rate for Payer: Three Rivers PPO |
$14.20
|
| Rate for Payer: TriWest Veterans Administration |
$10.79
|
| Rate for Payer: United Healthcare Commercial |
$18.08
|
| Rate for Payer: United Healthcare Medicare |
$10.79
|
| Rate for Payer: WINHealth Partners Commercial |
$18.55
|
| Rate for Payer: Wise Provider Network Commercial |
$17.98
|
|
|
DOXYCYCLINE HYCLATE 100 MG INTRAVENOUS POWDER FOR SOLUTION [11178]
|
Facility
|
OP
|
$63.32
|
|
|
Service Code
|
NDC 6838291010
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$34.29 |
| Max. Negotiated Rate |
$63.32 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$62.05
|
| Rate for Payer: Aetna of WY Medicare |
$41.79
|
| Rate for Payer: Altius Commercial |
$60.79
|
| Rate for Payer: Beech Street Commercial |
$62.05
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$61.42
|
| Rate for Payer: Cash Price |
$44.32
|
| Rate for Payer: ChoiceCare Network Commercial |
$61.42
|
| Rate for Payer: Cigna of WY Commercial |
$62.05
|
| Rate for Payer: Entrust Commercial |
$60.15
|
| Rate for Payer: First Choice Health Commercial |
$60.15
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$60.15
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$36.09
|
| Rate for Payer: HealthUtah PPO |
$63.32
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$61.42
|
| Rate for Payer: Multiplan Medicare/VA |
$34.29
|
| Rate for Payer: One Health Plan of WY PPO |
$62.05
|
| Rate for Payer: PacificSource Commercial |
$56.99
|
| Rate for Payer: PHCS PPO |
$62.05
|
| Rate for Payer: Three Rivers PPO |
$47.49
|
| Rate for Payer: TriWest Veterans Administration |
$36.09
|
| Rate for Payer: United Healthcare Commercial |
$60.47
|
| Rate for Payer: United Healthcare Medicare |
$36.09
|
| Rate for Payer: WINHealth Partners Commercial |
$62.05
|
| Rate for Payer: Wise Provider Network Commercial |
$60.15
|
|
|
DOXYCYCLINE HYCLATE 100 MG INTRAVENOUS POWDER FOR SOLUTION [11178]
|
Facility
|
IP
|
$63.32
|
|
|
Service Code
|
NDC 6838291001
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$36.69 |
| Max. Negotiated Rate |
$63.32 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$62.05
|
| Rate for Payer: Aetna of WY Medicare |
$40.52
|
| Rate for Payer: Altius Commercial |
$60.79
|
| Rate for Payer: Beech Street Commercial |
$62.05
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$61.42
|
| Rate for Payer: Cash Price |
$44.32
|
| Rate for Payer: ChoiceCare Network Commercial |
$61.42
|
| Rate for Payer: Cigna of WY Commercial |
$62.05
|
| Rate for Payer: Entrust Commercial |
$60.15
|
| Rate for Payer: First Choice Health Commercial |
$60.15
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$60.15
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$38.63
|
| Rate for Payer: HealthUtah PPO |
$63.32
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$61.42
|
| Rate for Payer: Multiplan Medicare/VA |
$36.69
|
| Rate for Payer: One Health Plan of WY PPO |
$62.05
|
| Rate for Payer: PacificSource Commercial |
$56.99
|
| Rate for Payer: PHCS PPO |
$62.05
|
| Rate for Payer: Three Rivers PPO |
$47.49
|
| Rate for Payer: TriWest Veterans Administration |
$38.63
|
| Rate for Payer: United Healthcare Commercial |
$60.47
|
| Rate for Payer: United Healthcare Medicare |
$38.63
|
| Rate for Payer: WINHealth Partners Commercial |
$60.15
|
| Rate for Payer: Wise Provider Network Commercial |
$60.15
|
|
|
DOXYCYCLINE HYCLATE 100 MG INTRAVENOUS POWDER FOR SOLUTION [11178]
|
Facility
|
IP
|
$63.32
|
|
|
Service Code
|
NDC 6838291010
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$36.69 |
| Max. Negotiated Rate |
$63.32 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$62.05
|
| Rate for Payer: Aetna of WY Medicare |
$40.52
|
| Rate for Payer: Altius Commercial |
$60.79
|
| Rate for Payer: Beech Street Commercial |
$62.05
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$61.42
|
| Rate for Payer: Cash Price |
$44.32
|
| Rate for Payer: ChoiceCare Network Commercial |
$61.42
|
| Rate for Payer: Cigna of WY Commercial |
$62.05
|
| Rate for Payer: Entrust Commercial |
$60.15
|
| Rate for Payer: First Choice Health Commercial |
$60.15
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$60.15
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$38.63
|
| Rate for Payer: HealthUtah PPO |
$63.32
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$61.42
|
| Rate for Payer: Multiplan Medicare/VA |
$36.69
|
| Rate for Payer: One Health Plan of WY PPO |
$62.05
|
| Rate for Payer: PacificSource Commercial |
$56.99
|
| Rate for Payer: PHCS PPO |
$62.05
|
| Rate for Payer: Three Rivers PPO |
$47.49
|
| Rate for Payer: TriWest Veterans Administration |
$38.63
|
| Rate for Payer: United Healthcare Commercial |
$60.47
|
| Rate for Payer: United Healthcare Medicare |
$38.63
|
| Rate for Payer: WINHealth Partners Commercial |
$60.15
|
| Rate for Payer: Wise Provider Network Commercial |
$60.15
|
|
|
DOXYCYCLINE HYCLATE 100 MG INTRAVENOUS POWDER FOR SOLUTION [11178]
|
Facility
|
OP
|
$63.32
|
|
|
Service Code
|
NDC 6838291001
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$34.29 |
| Max. Negotiated Rate |
$63.32 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$62.05
|
| Rate for Payer: Aetna of WY Medicare |
$41.79
|
| Rate for Payer: Altius Commercial |
$60.79
|
| Rate for Payer: Beech Street Commercial |
$62.05
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$61.42
|
| Rate for Payer: Cash Price |
$44.32
|
| Rate for Payer: ChoiceCare Network Commercial |
$61.42
|
| Rate for Payer: Cigna of WY Commercial |
$62.05
|
| Rate for Payer: Entrust Commercial |
$60.15
|
| Rate for Payer: First Choice Health Commercial |
$60.15
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$60.15
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$36.09
|
| Rate for Payer: HealthUtah PPO |
$63.32
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$61.42
|
| Rate for Payer: Multiplan Medicare/VA |
$34.29
|
| Rate for Payer: One Health Plan of WY PPO |
$62.05
|
| Rate for Payer: PacificSource Commercial |
$56.99
|
| Rate for Payer: PHCS PPO |
$62.05
|
| Rate for Payer: Three Rivers PPO |
$47.49
|
| Rate for Payer: TriWest Veterans Administration |
$36.09
|
| Rate for Payer: United Healthcare Commercial |
$60.47
|
| Rate for Payer: United Healthcare Medicare |
$36.09
|
| Rate for Payer: WINHealth Partners Commercial |
$62.05
|
| Rate for Payer: Wise Provider Network Commercial |
$60.15
|
|
|
DOXYCYCLINE HYCLATE 100 MG TABLET [19334]
|
Facility
|
IP
|
$28.41
|
|
|
Service Code
|
NDC 5026827911
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$16.46 |
| Max. Negotiated Rate |
$28.41 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$27.84
|
| Rate for Payer: Aetna of WY Medicare |
$18.18
|
| Rate for Payer: Altius Commercial |
$27.27
|
| Rate for Payer: Beech Street Commercial |
$27.84
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$27.56
|
| Rate for Payer: Cash Price |
$19.89
|
| Rate for Payer: ChoiceCare Network Commercial |
$27.56
|
| Rate for Payer: Cigna of WY Commercial |
$27.84
|
| Rate for Payer: Entrust Commercial |
$26.99
|
| Rate for Payer: First Choice Health Commercial |
$26.99
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$26.99
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$17.33
|
| Rate for Payer: HealthUtah PPO |
$28.41
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$27.56
|
| Rate for Payer: Multiplan Medicare/VA |
$16.46
|
| Rate for Payer: One Health Plan of WY PPO |
$27.84
|
| Rate for Payer: PacificSource Commercial |
$25.57
|
| Rate for Payer: PHCS PPO |
$27.84
|
| Rate for Payer: Three Rivers PPO |
$21.31
|
| Rate for Payer: TriWest Veterans Administration |
$17.33
|
| Rate for Payer: United Healthcare Commercial |
$27.13
|
| Rate for Payer: United Healthcare Medicare |
$17.33
|
| Rate for Payer: WINHealth Partners Commercial |
$26.99
|
| Rate for Payer: Wise Provider Network Commercial |
$26.99
|
|
|
DOXYCYCLINE HYCLATE 100 MG TABLET [19334]
|
Facility
|
OP
|
$28.41
|
|
|
Service Code
|
NDC 5026827911
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$15.38 |
| Max. Negotiated Rate |
$28.41 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$27.84
|
| Rate for Payer: Aetna of WY Medicare |
$18.75
|
| Rate for Payer: Altius Commercial |
$27.27
|
| Rate for Payer: Beech Street Commercial |
$27.84
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$27.56
|
| Rate for Payer: Cash Price |
$19.89
|
| Rate for Payer: ChoiceCare Network Commercial |
$27.56
|
| Rate for Payer: Cigna of WY Commercial |
$27.84
|
| Rate for Payer: Entrust Commercial |
$26.99
|
| Rate for Payer: First Choice Health Commercial |
$26.99
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$26.99
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$16.19
|
| Rate for Payer: HealthUtah PPO |
$28.41
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$27.56
|
| Rate for Payer: Multiplan Medicare/VA |
$15.38
|
| Rate for Payer: One Health Plan of WY PPO |
$27.84
|
| Rate for Payer: PacificSource Commercial |
$25.57
|
| Rate for Payer: PHCS PPO |
$27.84
|
| Rate for Payer: Three Rivers PPO |
$21.31
|
| Rate for Payer: TriWest Veterans Administration |
$16.19
|
| Rate for Payer: United Healthcare Commercial |
$27.13
|
| Rate for Payer: United Healthcare Medicare |
$16.19
|
| Rate for Payer: WINHealth Partners Commercial |
$27.84
|
| Rate for Payer: Wise Provider Network Commercial |
$26.99
|
|
|
DOXYCYCLINE MONOHYDRATE 100 MG TABLET [7737]
|
Facility
|
OP
|
$23.80
|
|
|
Service Code
|
NDC 6068734425
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$12.89 |
| Max. Negotiated Rate |
$23.80 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$23.32
|
| Rate for Payer: Aetna of WY Medicare |
$15.71
|
| Rate for Payer: Altius Commercial |
$22.85
|
| Rate for Payer: Beech Street Commercial |
$23.32
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$23.09
|
| Rate for Payer: Cash Price |
$16.66
|
| Rate for Payer: ChoiceCare Network Commercial |
$23.09
|
| Rate for Payer: Cigna of WY Commercial |
$23.32
|
| Rate for Payer: Entrust Commercial |
$22.61
|
| Rate for Payer: First Choice Health Commercial |
$22.61
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$22.61
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$13.57
|
| Rate for Payer: HealthUtah PPO |
$23.80
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$23.09
|
| Rate for Payer: Multiplan Medicare/VA |
$12.89
|
| Rate for Payer: One Health Plan of WY PPO |
$23.32
|
| Rate for Payer: PacificSource Commercial |
$21.42
|
| Rate for Payer: PHCS PPO |
$23.32
|
| Rate for Payer: Three Rivers PPO |
$17.85
|
| Rate for Payer: TriWest Veterans Administration |
$13.57
|
| Rate for Payer: United Healthcare Commercial |
$22.73
|
| Rate for Payer: United Healthcare Medicare |
$13.57
|
| Rate for Payer: WINHealth Partners Commercial |
$23.32
|
| Rate for Payer: Wise Provider Network Commercial |
$22.61
|
|
|
DOXYCYCLINE MONOHYDRATE 100 MG TABLET [7737]
|
Facility
|
IP
|
$23.80
|
|
|
Service Code
|
NDC 6068734425
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$13.79 |
| Max. Negotiated Rate |
$23.80 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$23.32
|
| Rate for Payer: Aetna of WY Medicare |
$15.23
|
| Rate for Payer: Altius Commercial |
$22.85
|
| Rate for Payer: Beech Street Commercial |
$23.32
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$23.09
|
| Rate for Payer: Cash Price |
$16.66
|
| Rate for Payer: ChoiceCare Network Commercial |
$23.09
|
| Rate for Payer: Cigna of WY Commercial |
$23.32
|
| Rate for Payer: Entrust Commercial |
$22.61
|
| Rate for Payer: First Choice Health Commercial |
$22.61
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$22.61
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$14.52
|
| Rate for Payer: HealthUtah PPO |
$23.80
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$23.09
|
| Rate for Payer: Multiplan Medicare/VA |
$13.79
|
| Rate for Payer: One Health Plan of WY PPO |
$23.32
|
| Rate for Payer: PacificSource Commercial |
$21.42
|
| Rate for Payer: PHCS PPO |
$23.32
|
| Rate for Payer: Three Rivers PPO |
$17.85
|
| Rate for Payer: TriWest Veterans Administration |
$14.52
|
| Rate for Payer: United Healthcare Commercial |
$22.73
|
| Rate for Payer: United Healthcare Medicare |
$14.52
|
| Rate for Payer: WINHealth Partners Commercial |
$22.61
|
| Rate for Payer: Wise Provider Network Commercial |
$22.61
|
|
|
DOXYCYCLINE MONOHYDRATE 100 MG TABLET [7737]
|
Facility
|
OP
|
$23.80
|
|
|
Service Code
|
NDC 6068734495
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$12.89 |
| Max. Negotiated Rate |
$23.80 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$23.32
|
| Rate for Payer: Aetna of WY Medicare |
$15.71
|
| Rate for Payer: Altius Commercial |
$22.85
|
| Rate for Payer: Beech Street Commercial |
$23.32
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$23.09
|
| Rate for Payer: Cash Price |
$16.66
|
| Rate for Payer: ChoiceCare Network Commercial |
$23.09
|
| Rate for Payer: Cigna of WY Commercial |
$23.32
|
| Rate for Payer: Entrust Commercial |
$22.61
|
| Rate for Payer: First Choice Health Commercial |
$22.61
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$22.61
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$13.57
|
| Rate for Payer: HealthUtah PPO |
$23.80
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$23.09
|
| Rate for Payer: Multiplan Medicare/VA |
$12.89
|
| Rate for Payer: One Health Plan of WY PPO |
$23.32
|
| Rate for Payer: PacificSource Commercial |
$21.42
|
| Rate for Payer: PHCS PPO |
$23.32
|
| Rate for Payer: Three Rivers PPO |
$17.85
|
| Rate for Payer: TriWest Veterans Administration |
$13.57
|
| Rate for Payer: United Healthcare Commercial |
$22.73
|
| Rate for Payer: United Healthcare Medicare |
$13.57
|
| Rate for Payer: WINHealth Partners Commercial |
$23.32
|
| Rate for Payer: Wise Provider Network Commercial |
$22.61
|
|
|
DOXYCYCLINE MONOHYDRATE 100 MG TABLET [7737]
|
Facility
|
IP
|
$23.80
|
|
|
Service Code
|
NDC 6068734495
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$13.79 |
| Max. Negotiated Rate |
$23.80 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$23.32
|
| Rate for Payer: Aetna of WY Medicare |
$15.23
|
| Rate for Payer: Altius Commercial |
$22.85
|
| Rate for Payer: Beech Street Commercial |
$23.32
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$23.09
|
| Rate for Payer: Cash Price |
$16.66
|
| Rate for Payer: ChoiceCare Network Commercial |
$23.09
|
| Rate for Payer: Cigna of WY Commercial |
$23.32
|
| Rate for Payer: Entrust Commercial |
$22.61
|
| Rate for Payer: First Choice Health Commercial |
$22.61
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$22.61
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$14.52
|
| Rate for Payer: HealthUtah PPO |
$23.80
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$23.09
|
| Rate for Payer: Multiplan Medicare/VA |
$13.79
|
| Rate for Payer: One Health Plan of WY PPO |
$23.32
|
| Rate for Payer: PacificSource Commercial |
$21.42
|
| Rate for Payer: PHCS PPO |
$23.32
|
| Rate for Payer: Three Rivers PPO |
$17.85
|
| Rate for Payer: TriWest Veterans Administration |
$14.52
|
| Rate for Payer: United Healthcare Commercial |
$22.73
|
| Rate for Payer: United Healthcare Medicare |
$14.52
|
| Rate for Payer: WINHealth Partners Commercial |
$22.61
|
| Rate for Payer: Wise Provider Network Commercial |
$22.61
|
|
|
DOXYCYCLINE MONOHYDRATE 50 MG CAPSULE [9791]
|
Facility
|
IP
|
$17.17
|
|
|
Service Code
|
NDC 5026828011
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$9.95 |
| Max. Negotiated Rate |
$17.17 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$16.83
|
| Rate for Payer: Aetna of WY Medicare |
$10.99
|
| Rate for Payer: Altius Commercial |
$16.48
|
| Rate for Payer: Beech Street Commercial |
$16.83
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$16.65
|
| Rate for Payer: Cash Price |
$12.02
|
| Rate for Payer: ChoiceCare Network Commercial |
$16.65
|
| Rate for Payer: Cigna of WY Commercial |
$16.83
|
| Rate for Payer: Entrust Commercial |
$16.31
|
| Rate for Payer: First Choice Health Commercial |
$16.31
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$16.31
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$10.47
|
| Rate for Payer: HealthUtah PPO |
$17.17
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$16.65
|
| Rate for Payer: Multiplan Medicare/VA |
$9.95
|
| Rate for Payer: One Health Plan of WY PPO |
$16.83
|
| Rate for Payer: PacificSource Commercial |
$15.45
|
| Rate for Payer: PHCS PPO |
$16.83
|
| Rate for Payer: Three Rivers PPO |
$12.88
|
| Rate for Payer: TriWest Veterans Administration |
$10.47
|
| Rate for Payer: United Healthcare Commercial |
$16.40
|
| Rate for Payer: United Healthcare Medicare |
$10.47
|
| Rate for Payer: WINHealth Partners Commercial |
$16.31
|
| Rate for Payer: Wise Provider Network Commercial |
$16.31
|
|
|
DOXYCYCLINE MONOHYDRATE 50 MG CAPSULE [9791]
|
Facility
|
OP
|
$17.17
|
|
|
Service Code
|
NDC 5026828011
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$9.30 |
| Max. Negotiated Rate |
$17.17 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$16.83
|
| Rate for Payer: Aetna of WY Medicare |
$11.33
|
| Rate for Payer: Altius Commercial |
$16.48
|
| Rate for Payer: Beech Street Commercial |
$16.83
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$16.65
|
| Rate for Payer: Cash Price |
$12.02
|
| Rate for Payer: ChoiceCare Network Commercial |
$16.65
|
| Rate for Payer: Cigna of WY Commercial |
$16.83
|
| Rate for Payer: Entrust Commercial |
$16.31
|
| Rate for Payer: First Choice Health Commercial |
$16.31
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$16.31
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$9.79
|
| Rate for Payer: HealthUtah PPO |
$17.17
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$16.65
|
| Rate for Payer: Multiplan Medicare/VA |
$9.30
|
| Rate for Payer: One Health Plan of WY PPO |
$16.83
|
| Rate for Payer: PacificSource Commercial |
$15.45
|
| Rate for Payer: PHCS PPO |
$16.83
|
| Rate for Payer: Three Rivers PPO |
$12.88
|
| Rate for Payer: TriWest Veterans Administration |
$9.79
|
| Rate for Payer: United Healthcare Commercial |
$16.40
|
| Rate for Payer: United Healthcare Medicare |
$9.79
|
| Rate for Payer: WINHealth Partners Commercial |
$16.83
|
| Rate for Payer: Wise Provider Network Commercial |
$16.31
|
|
|
DRAINAGE EXTERNAL AUDITORY CANAL ABSCESS
|
Professional
|
Both
|
$616.00
|
|
|
Service Code
|
HCPCS 69020
|
| Min. Negotiated Rate |
$119.75 |
| Max. Negotiated Rate |
$616.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$603.68
|
| Rate for Payer: Aetna of WY Medicare |
$140.88
|
| Rate for Payer: Beech Street Commercial |
$585.20
|
| Rate for Payer: Cash Price |
$431.20
|
| Rate for Payer: Cash Price |
$431.20
|
| Rate for Payer: ChoiceCare Network Commercial |
$597.52
|
| Rate for Payer: Cigna of WY Commercial |
$603.68
|
| Rate for Payer: First Choice Health Commercial |
$554.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$585.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$140.88
|
| Rate for Payer: HealthUtah PPO |
$616.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$597.52
|
| Rate for Payer: Multiplan Medicare/VA |
$119.75
|
| Rate for Payer: One Health Plan of WY PPO |
$603.68
|
| Rate for Payer: PacificSource Commercial |
$554.40
|
| Rate for Payer: PHCS PPO |
$585.20
|
| Rate for Payer: Three Rivers PPO |
$462.00
|
| Rate for Payer: TriWest Veterans Administration |
$140.88
|
| Rate for Payer: United Healthcare Commercial |
$585.20
|
| Rate for Payer: WINHealth Partners Commercial |
$523.60
|
|
